Posttraumatic Arthritis After Anterior Cruciate Ligament Injury: Machine Learning Comparison Between Surgery and Nonoperative Management.
Background: Nonoperative and operative management techniques after anterior cruciate ligament (ACL) injury are both appropriate treatment options for selected patients. However, the subsequent development of posttraumatic knee osteoarthritis (PTOA) remains an area of active study. Purpose: To compar...
| Publicado en: | American Journal of Sports Medicine Vol. 53; no. 5; pp. 1050 - 1061 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Apr2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=184107733&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 184107733 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03635465 ASM jtl: American Journal of Sports Medicine issn: 03635465 maglogo: Y pubinfo: dt: Apr2025 vid: 53 iid: 5 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 184107733 183635101 184107733 184107733 10.1177/03635465251322803 184107733 ppf: 1050 ppct: 11 formats: tig: atl: Posttraumatic Arthritis After Anterior Cruciate Ligament Injury: Machine Learning Comparison Between Surgery and Nonoperative Management. aug: au: Lu, Yining Jurgensmeier, Kevin Lamba, Abhinav Yang, Linjun Hevesi, Mario Camp, Christopher L. Krych, Aaron J. Stuart, Michael J. affil: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA sug: subj: Osteoarthritis, Knee Surgery Osteoarthritis, Knee Therapy Osteoarthritis, Knee Risk Factors Anterior Cruciate Ligament Injuries Complications Machine Learning Methods Surgery, Operative Treatment Outcomes Anterior Cruciate Ligament Reconstruction Methods Anterior Cruciate Ligament Injuries Surgery Human Male Female Adult Middle Age Comparative Studies Disease Progression Arthroplasty, Replacement, Knee Descriptive Statistics Prospective Studies Orthopedic Surgery Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Background: Nonoperative and operative management techniques after anterior cruciate ligament (ACL) injury are both appropriate treatment options for selected patients. However, the subsequent development of posttraumatic knee osteoarthritis (PTOA) remains an area of active study. Purpose: To compare the risk of PTOA between patients treated without surgery and with ACL reconstruction (ACLR) after primary ACL disruption using a machine learning causal inference model. Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database identified patients undergoing ACLR between 1990 and 2016 with minimum 7.5-year follow-up. Variables collected include age, sex, body mass index, activity level, occupation, relevant comorbid diagnoses, radiographic findings, injury characteristics, and clinical course. Treatment effects of ACLR on the development of PTOA and progression to total knee arthroplasty (TKA) were analyzed with machine learning models (MLMs) in a causal inference estimator (targeted maximum likelihood estimation, TMLE), while controlling for confounders. Results: The study included 1194 patients with a minimum follow-up of 7.5 years, among whom 974 underwent primary reconstruction and 220 underwent nonoperative treatment. A total of 215 (22%) patients developed symptomatic PTOA in the ACLR group compared with 140 (64%) in the nonoperative treatment group (P <.001), whereas 25 (3%) patients underwent TKA in the ACLR group compared with 50 (23%) in the nonoperative treatment group (P <.001). Patients in the ACLR group had delayed TKA compared with patients in the nonoperative treatment group (193.4 vs 166.0 months, respectively; P =.02). TMLE evaluation revealed that reconstruction decreased the risk of PTOA by 11% (95% CI, 8%-13%; P <.001) compared with nonoperative treatment but did not demonstrate a significant effect on the rate of progression to TKA. Survival analysis with random forest algorithm demonstrated significant delay to the onset of PTOA as well as time to progression of TKA in patients undergoing ACLR. Additional risk factors for the development of PTOA, irrespective of treatment, included older age at injury, greater body mass index, total number of arthroscopic knee surgeries, and residual laxity at follow-up. Conclusion: MLMs in a causal inference estimator found ACLR to exert a significant treatment effect in reducing the rate of development of PTOA by 11% compared with nonoperative treatment. ACLR also delayed the onset of PTOA and progression to TKA. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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